Applying Research for Better Public Health Decisions
Public health managers make critical decisions regularly. Do we use targeted or universal strategies to reduce alcohol-exposed pregnancies? Do we add a translation and interpretation service to address linguistic diversity? Do we continue saying that breastfeeding infants improves their cognitive performance?
Whether it is adding a new program, discontinuing an existing one, or changing its focus, these decisions affect the health of residents and the use of scarce resources. Dr. Megan Ward, Associate Medical Officer of Health at Peel Public Health is glad that she can rely on the Applicability and Transferability of Evidence (A&T) tool, developed by the National Collaborating Centre for Methods and Tools (NCCMT), to help her group make better decisions about the best available programs and services for her region.
The A&T tool provides a process to assess the applicability and transferability of research evidence to practice decisions by exploring 21 questions or criteria. It assesses applicability by asking, "Can the intervention work for us?" - probing issues such as political and social acceptability, resource availability and organizational capacity. Transferability questions determine whether a program will work in the proposed setting, with similar results. They delve into the magnitude of the health issue locally, the reach and cost effectiveness of the intervention, and the characteristics of the target population.
"Public Health decisions are made in a very complex environment, with political considerations, a number of partners, and different population dynamics. The A&T tool considers all of them," says Megan.
Peel Public Health has been using the A&T tool as part of its Rapid Review process since 2010, making almost twenty decisions on various public health topics so far. The process brings in staff affected by the decision in a facilitated, systematic discussion that aims to bring clarity to the gap between what research says and actual practice. Using the A&T tool helps build team consensus and reassures staff that decisions are reached only after considering a full range of options.
The process is fairly lengthy, though, with a two-hour discussion only the beginning. It requires advanced scheduling to get a good range of participants and a senior decision-maker with a system-level perspective for effective implementation. Also, facilitators should be prepared to address the passions that arise from the discussion.
In the end it is worth it, according to Megan, "The structured conversation we have using the questions in the A&T tool gives me a lot of confidence that the decisions we make are much better."
A review of the Applicability and Transferability of Evidence tool (A&T) is available on the NCCMT website, at <<http://www.nccmt.ca/registry/view/eng/24.html>> The A&T tool is available here: << http://www.nccmt.ca/uploads/media/media/0001/01/a13748201ebe5a6793cc641b109e21c70307dfdc.pdf >>